Top 100 Surgical Secrets
6/03/2009 03:30:00 PM | Author: fadzly ex-extenders
These secrets are 100 of the top board alerts. They summarize the concepts, principles, and most salient details of surgical practice.

1. Clinical determinants of brain death are the loss of the papillary, corneal, oculovestibular, oculocephalic, oropharyngeal, and respiratory reflexes for > 6 hours. The patient should also undergo an apnea test, in which the pCO2 is allowed to rise to at least 60 mmHg without coexistent hypoxia. The patient should be observed for the absence of spontaneous breathing.

2. The estimated risks of HBV, HCV, and HIV transmission by blood transfusion in the United States are 1 in 205,000 for HBV, 1 in 1,935,000 for HCV, and 1 in 2,135,000 for HIV.

3. The most common location of an undescended testis is the inguinal canal.

4. The most common solid renal mass in infancy is a congenital mesoblastic nephroma and in childhood a Wilms' tumor.

5. Ogilvie's syndrome is acute massive dilatation of the cecum and the ascending and transverse colon without organic obstruction.

6. The best screening method for prostate cancer is digital rectal exam combined with serum prostate-specific antigen.

7. The most common histologic type of bladder cancer is transitional cell carcinoma.

8. Carcinoma in situ of the bladder is treated with immunotherapy with intravesical bacillus Calmette-Guérin (BCG).LOLZ.. BCG used for Ca?

9. Localized renal cell carcinoma is treated with surgery (radical nephrectomy).

10.The most common cause of male infertility is varicocele.

11. The most common nonbacterial cause of pneumonia in transplant patients is cytomegalovirus.

12. Chimerism is leukocyte sharing between the graft and the recipient so that the graft becomes a genetic composite of both the donor and the recipient.

13. OKT3 is a mouse monoclonal antibody that binds to and blocks the T-cell CD3 receptor.

14. The most common disease requiring liver transplant is hepatitis C.

15. Cystic hygroma is a congenital malformation with a predilection for the neck. It is a benign lesion that usually presents as a soft mass in the lateral neck.


16. In neuroblastomas, age at presentation is the major prognostic factor. Children younger than 1 year have an overall survival rate > 70%, whereas the survival rate for children older than 1 year is < 35%.
17. The most feared complication of diaphragmatic hernia is persistent fetal circulation.
18. The three most common variants of tracheoesophageal fistula are (1) proximal esophageal atresia with distal tracheoesophageal fistula, (2) isolated esophageal atresia, and (3) tracheo-esophageal fistula with esophageal atresia.
19. Atresia can occur anywhere in the GI tract: duodenal (50%), jejunoileal (45%), or colonic (5%). Duodenal atresia arises from failure of recanalization during the 8th-10th week of gestation; jejunoileal and colonic atresia are caused by an in utero mesenteric vascular accident.
20. The types of aortic dissection are ascending (type A) dissection, which involves only the ascending or both the ascending and descending aorta, and descending dissection (type B), which involves only the descending aorta.


21. A solitary pulmonary nodule is < 3 cm and is discrete on chest radiograph. It is usually surrounded by lung parenchyma.
22. Mediastinal staging is indicated in patients with apparent or documented lung cancer who have (1) known lung cancer with mediastinal nodes > 1 cm accessible by cervical mediastinal exploration, as assessed by CT scan; (2) adenocarcinoma of the lung and multiple mediastinal lymph nodes < 1 cm; (3) central or large (> 5 cm) lung cancers with mediastinal lymph nodes < 1 cm; and (4) lung cancer with risk of thoracotomy and lung resection.
23. The most common causes of aortic stenosis are now congenital anomalies and calcific (degenerative) disease.
24. In mitral regurgitation, the left ventricle ejects blood via two routes: (1) antegrade, through the aortic valve, or (2) retrograde, through the mitral valve. The amount of each stroke volume ejected retrograde into the left atrium is the regurgitant fraction. To compensate for the regurgitant fraction, the left ventricle must increase its total stroke volume. This ultimately produces volume overload of the left ventricle and leads to ventricular dysfunction.
25. The indications for CABG are (1) left main coronary artery stenosis; (2) three-vessel coronary artery disease (70% stenosis) with depressed left ventricular (LV) function or two-vessel coronary artery disease (CAD) with proximal left anterior descending (LAD) involvement; and (3) angina despite aggressive medical therapy.
26. Hibernating myocardium is improved by CABG. Myocardial hibernation refers to the reversible myocardial contractile function associated with a decrease in coronary flow in the setting of preserved myocardial viability. Some patients with global systolic dysfunction exhibit dramatic improvement in myocardial contractility after CABG.
27. The surgical treatment of ulcerative colitis is total colectomy with ileoanal pouch anastomosis.
28. Dieulafoy's ulcer is a gastric vascular malformation with an exposed submucosal artery, usually within 2-5 cm of the gastroesophageal junction. It presents with painless hematemesis, often massive.
29. The role of blind subtotal colectomy in the management of massive lower gastrointestinal bleeding is limited to a small group of patients in whom a specific bleeding source cannot be identified. The procedure is associated with a 16% mortality rate.
30. Colorectal polyps < 2 cm have a 2% risk of containing cancer, 2 cm polyps have a 10% risk, and polyps > 2 cm have a cancer risk of 40%. Sixty percent of villous polyps are > 2 cm, and 77% of tubular polyps are < 1 cm at the time of discovery.
31. Patients with colorectal cancer with lymph node involvement (Dukes' C) should receive chemotherapy postoperatively to treat micrometastases.
32. Goodsall's rule states the location of the internal opening of an anorectal fistula is based on the position of the external opening. An external opening posterior to a line drawn transversely across the perineum originates from an internal opening in the posterior midline. An external opening, anterior to this line, originates from the nearest anal crypt in a radial direction.
Incarcerated inguinal hernia: structures in the hernia sac still have a good blood supply but are stuck in the sac because of adhesions or a narrow neck of the hernia sac. Strangulated inguinal hernia: hernia structures have a compromised blood supply because of anatomic constriction at the neck of the hernia.


33. Incarcerated inguinal hernia: structures in the hernia sac still have a good blood supply but are stuck in the sac because of adhesions or a narrow neck of the hernia sac. Strangulated inguinal hernia: hernia structures have a compromised blood supply because of anatomic constriction at the neck of the hernia.
34. Chvostek's sign is spasm of the facial muscles caused by tapping the facial nerve trunk. Trousseau's sign is carpal spasm elicited by occlusion of the brachial artery for 3 minutes with a blood pressure cuff.
35. The two surgical options for Graves' disease are subtotal thyroidectomy or near-total thyroidectomy.
36. The only biochemical test that is routinely needed to identify patients with unsuspected hyperthyroidism is serum thyroid-stimulating hormone concentration.
37. The surgically correctable causes of hypertension are renovascular hypertension, pheochromocytoma, Cushing's syndrome, primary hyperaldosteronism, coarctation of the aorta, and unilateral renal parenchymal disease.
38. The "triple negative test" or "diagnostic triad" for diagnosing a palpable breast mass includes physical examination, breast imaging, and biopsy.
39. Chest wall radiation is indicated after mastectomy in patients with greater than 5 cm primary cancers, positive mastectomy margins, or more than four positive lymph nodes, all of which are associated with heightened locoregional recurrence rates.
40. Sentinel lymph nodes are the first stop for tumor cells metastasizing through lymphatics from the primary tumor.
41. The most common site of origin of subungual melanomas is the great toe. Amputation at or proximal to the metatarsal phalangeal joint and regional sentinel lymph node biopsy are advised by most authors.
42. Ramus marginalis mandibularis, the lowest branch of the nerve that innervates the depressor muscles of the lower lip, is the most commonly injured facial nerve branch during parotidectomy.
43. Waldeyer's ring is the mucosa of the posterior oropharynx covering a bed of lymphatic tissue that aggregates to form the palatine, lingual, pharyngeal, and tubal tonsils. These structures form a ring around the pharyngeal wall. This may be the site of primary or metastatic tumor.
44. A patient in whom the head and neck examination is completely normal but FNA of a cervical node reveals squamous cancer should have examination of the mouth, pharynx, larynx, esophagus, and tracheobronchial tree under anesthesia (triple endoscopy). If nothing is seen, blind biopsy of the nasopharynx, tonsils, base of tongue, and pyriform sinuses should be done at the same sitting.
45. The microorganisms implicated in atherosclerosis include Chlamydia pneumoniae, Helicobacter pylori, streptococci, and Bacillus typhosus.
46. The cumulative 10-year amputation rate for claudication is 10%.
47. The absolute reduction in risk of stroke is 6% over a 5-year period in asymptomatic patients with > 60% stenosis who undergo carotid endarterectomy plus aspirin versus patients treated with aspirin alone (5.1% versus 11%).
48. Abdominal aortic aneurysm's average expansion rate is 0.4 cm/year.
49. Heparin binds to antithrombin III, rendering it more active.
50. The patient with suspected intermittent claudication should initially be evaluated by obtaining ankle brachial index or segmental limb pressures at rest.
51. Shock is suboptimal consumption of O2 and excretion of CO2 at the cellular level.
52. Nitric oxide is synthesized in vascular endothelial cells by constitutive nitric oxide synthase and inducible NOS, using arginine as the substrate.
53. Saliva has the hightest potassium concentration (20 mEq), followed by gastric secretions (10 mEq), then pancreatic and duodenal secretions (5 mEq).
54. Basal caloric expenditure = 25 kcal/kg/day with a requirement of approximately 1 g protein/kg/day.
55. 6.25 g of protein contains 1 g of nitrogen.
56. Dextrose has 3.4 kcal/g, protein 4 kcal/g, fat 9 kcal/g (20% lipid solution delivers 2 kcal/mL).
57. Maximal glucose infusion rates in parenteral formulas should not exceed 5 mg/kg/min.
58. Refeeding syndrome occurs in moderately to severely malnourished patients (e.g., chronic alcoholism or anorexia nervosa) who, upon presentation with a large nutrient load, develop clinically significant decreases in serum phosphorus, potassium, calcium, and magnesium levels. Hyperglycemia is common secondary to blunted insulin secretion. ATP production is mitigated, and the classic presentation is respiratory failure.
59. Glutamine is the most common amino acid found in muscle and plasma. Levels decrease after surgery and physiologic stress. Glutamine serves as a substrate for rapidly replicating cells (interestingly, it is also the number one metabolic substrate for neoplastic cells), maintains the integrity and function of the intestinal barrier, and protects against free radical damage by maintaing GSH levels. Glutamine is unstable in IV form unless linked as a dipeptide.
60. Fever is caused by activated macrophages that release interleukin-1, tumor necrosis factor, and interferon in response to bacteria and endotoxin. The result is a resetting of the hypothalamic thermoregulatory center.
61. Cardiac output = heart rate x stroke volume; normal CO is 5-6 L/min.
62. SVR = [(MAP - CVP)/CO] x 80; normal SVR is 800-1200 dyne.sec/cm-5.
63. Hypovolemic shock: low CVP and PCWP, low CO and SVO2, high SVR.
64. Cardiogenic shock: high CVP and PCWP, low CO and SVO2, variable SVR.
65. Septic shock: low or normal CVP and PCWP, high CO initially, high SVO2, low SVR.
66. Kehr's sign is concurrent LUQ and left shoulder pain, indicating diaphragmatic irritation from a ruptured spleen or subdiaphragmatic abscess. Anatomically, the diaphragm and the back of the left shoulder enjoy parallel innervation.
67. Rebound tenderness implies peritoneal inflammation and irritation not simply abdominal tenderness.
68. The 5 Ws of post-operative fever are wound (infection), water (UTI), wind (atelectasis, pneumonia), walking (thrombophlebitis), and wonder drugs (drug fevers).
69. Cricothyroidotomy should not be performed in patients <> 80 mmHg; femoral (groin) pulse estimates SBP > 70 mmHg; and carotid (neck) pulse estimates SBP > 60 mmHg.
71. A general rule for crystalloid infusion to replace blood loss is a 3:1 ratio of isotonic crystalloid to blood.
72. Raccoon eyes (periorbital ecchymosis) and Battle's sign (mastoid ecchymosis) are clinical indicators of basilar skull fracture.
73. CPP = MAP - ICP. Some debate exists on the minimum allowable CPP, but consensus indicates that a cerebral perfusion pressure of 50-70 mmHg is necessary.
74. Violation of the platysma defines a penetrating neck wound.
75. Tension pneumothorax is air accumulation in the pleural space eliciting increased intrathoracic pressure and resulting in a kinking of the SVC and IVC that compromises venous return to heart.
76. The most common site of thoracic aortic injury in blunt trauma is just distal to the take-off of the left subclavian artery.
77. The most common manifestation of blunt myocardial injury is arrhythmia.
78. Indications for thoracotomy in a stable patient with hemothorax include an immediate tube thoracostomy output of > 1500 mL and ongoing bleeding of 250 mL/h for 4 consective hours.
79. Beck's triad is hypotension, distended neck veins, and muffled heart sounds.
80. The hepatic artery supplies approximately 30% of blood flow to the liver while the portal vein supplies the remaining 70%. The oxygen delivery, however, is similar for both at 50%.
81. The Pringle maneuver is a manual occlusion of the hepatoduodenal ligament to interrupt blood flow to the liver.
82. Splenectomy significantly decreases IgM levels.
83. 90% of trauma fatalities due to pelvic fractures are due to venous bleeding and bone oozing; only 10% of fatal pelvic bleeding from blunt trauma is arterial (most common site is superior gluteal artery).
84. Intraperitoneal bladder rupture from blunt trauma: operative management; extraperitoneal rupture: observant management.
85. Pseudoaneurysm is a disruption of the arterial wall leading to a pulsatile hematoma contained by fibrous connective tissue (but not all three arterial wall layers, which defines a true aneurysm).
86. The earliest sign of lower extremity compartment syndrome is neurologic in the distribution of the peroneal nerve with numbness in the first dorsal webspace and weak dorsiflexion.
87. Posterior knee dislocations are associated with popliteal artery injuries and are an indication for angiography.
88. Management of suspected navicular fracture despite negative radiography is short-arm cast and repeat x-ray in 2 weeks; at high risk for avascular necrosis.
89. Parkland formula: lactated Ringer's at 4 mL/kg x %TBSA (second- and third-degree only) of burn. Infuse 50% of volume in first 8 hours and the remaining 50% over the subsequent 16 hours.
90. The metabolic rate peaks at 2.5 times the basal metabolic rate in severe burns > 50% TBSA.
91. Gallstones and alcohol abuse are the two main causes of acute pancreatitis.
92. Alcohol abuse accounts for 75% of cases of chronic pancreatitis.
93. Isolated gastric varices and hypersplenism indicate splenic vein thrombosis and are an indication for splenectomy.
94. The treatment for gallstone pancreatitis is cholecystectomy and intraoperative cholangiogram during the same hospital stay once the pancreatitis has subsided.
95. Proton pump inhibitors irreversibly inhibit the parietal cell hydrogen ion pump.
96. Definitive treatment of alkaline reflux gastritis after a Billroth II includes a Roux-en-Y gastro-jejunostomy from a 40-cm efferent jejunal limb.
97. Cushing's ulcer is a stress ulcer found in critically ill patients with central nervous system injury. It is typically single and deep, with a tendency to perforate.
98. Curling's ulcer is a stress ulcer found in critically ill patients with burn injuries.
99. Marginal ulcer is an ulcer found near the margin of gastroenteric anastomosis, usually on the small bowel side.
100. The most common cause of small bowel obstructions is adhesive disease; the second most common cause is hernias.


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TUMOURS OF THE PANCREAS
6/02/2009 09:59:00 PM | Author: fadzly ex-extenders
Let's talk about Pancreatic tumour. There are many types of pancreatic tumour. Although ductal carcinoma of the pancreas is one of the most lethal of all gastrointestinal tumours, 10–15% of tumours of the pancreas (including those of the periampullary region) are not of the same histological type as ductal carcinoma and have a much better prognosis. This group of tumours includes ampullary carcinoma, islet cell tumours of the pancreas and cystic tumours of the pancreas. A tumour of the pancreas should, therefore, not be assumed to carry a poor prognosis. Ok?

Ductal adenocarcinoma of the pancreas is highly malignant and has usually metastasised by the time of diagnosis. Smoking is the only recognised aetiological factor and the disease is uncommon under the age of 40. The disease occurs in the head of the pancreas in 80% of cases. It presents with obstructive jaundice in 70% of cases but may also present with severe upper abdominal pain (which may radiate into the back), weight loss, anorexia, malaise, or rarely, thrombophlebitis migrans.

On examination, there may be cervical lymphadenopathy, an abdominal mass, hepatomegaly or ascites. The gallbladder may be palpable. Courvoisier’s law states that if, in the presence of jaundice, the gallbladder is palpable, then the cause is unlikely to be gallstones. Investigations include basic blood tests and specific diagnosis by ultrasound, CT or MRI. The ERCP may be helpful too, and may also allow therapeutic manoeuvres such as stent insertion (see section on obstructive jaundice).

Most tumours are treated palliatively by insertion of a biliary stent or bypass surgery. Resectional surgery is suitable for 15–20% of patients with a ductal carcinoma but 50–75% of patients with ampullary carcinoma, islet cell tumours or cystic tumours of the pancreas. Five-year survival following curative resection in ductal carcinoma is 10–15% although resection is also associated with good relief of symptoms. For those with ampullary tumours, islet cell tumours or cystic tumours, 5 year survival of 40% can be anticipated.

For tumours of the head of the pancreas or peri-ampullary region, pancreatico-duodenectomy (Whipple’s operation) is the operation of choice. The pylorus-preserving operation is the operation of choice. The mortality rate of pancreatico-duodenectomy is less than 5%.



Whipple’s procedure (partial pancreatoduodenectomy) for carcinoma of the
head of pancreas (shaded).

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1st day of our Orthopaedic posting!
6/01/2009 08:11:00 PM | Author: fadzly ex-extenders
Good luck to my classmate. Jom pi wards dan clinics!














video
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Amik ko..
5/31/2009 07:19:00 PM | Author: Gpku
A 61-year-old woman presents to the emergency department (ED) after being referred from her primary care provider's (PCP) office for evaluation of tachycardia. She had been seen by her PCP for routine placement of a purified protein derivative (PPD) tuberculin skin test and was incidentally noted to have a pulse of 160 bpm. The patient currently denies any specific complaints other than occasional palpitations. On review of her systems, however, she notes having night sweats; a 110-lb (50-kg) weight loss over the preceding 12 months; and 2-3 months of anxiety, diarrhea, and occasional diplopia. She denies having any fever, chills, chest pain, dyspnea, or swelling in her extremities. She has a past medical history of an unspecified thyroid problem. She does not take any daily medications and has no medication allergies. She has a 50-pack-year smoking history, with occasional alcohol consumption. She had been homeless for a period of time but is currently living in an apartment.

On examination, the patient is awake and fully oriented. She is diaphoretic but in no apparent distress. Her temperature is 97.0°F (36.1°C); her pulse is 160 bpm; her respiratory rate is 24 breaths/min, with an oxygen saturation of 98%; and her blood pressure is 190/117 mm Hg. She has bilateral exophthalmos with exotropia of the right eye. Her visual acuity and extraocular movements are intact. The neck examination reveals a diffuse, nontender goiter, without nodules or thyroid bruits. The heart is tachycardic, intermittently irregular, and without murmurs. The lungs are clear to auscultation bilaterally. The abdomen is nondistended, soft, and nontender, with no palpable masses. There is no edema of the extremities. The neurologic examination reveals normal mentation, intact cranial nerves, intact motor strength and sensation, and normal reflexes. No tremor is noted.The initial laboratory studies reveal complete blood count, electrolytes, renal function, and cardiac marker findings that are all within normal limits. A plain chest radiograph is interpreted as normal.An electrocardiogram (ECG) is obtained.

I'll discuss more about this topic on the next issue..coming with more answers!!!..think it man..
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SURGERY: Biliary Tract
5/30/2009 08:27:00 PM | Author: fadzly ex-extenders
Topic today will be about Biliary tract


GALLSTONES

Gallstones are very common topic and are therefore frequently asked in the exams. Majority of them are asymptomatic and which require no treatment. However, they cause a wide range of clinical problems, depending on their position. They are either made up of cholesterol or pigment (bilirubin breakdown products) or a mixture of the two. Most (75%) gallstones are predominantly cholesterol. Pure pigment stones are rare (<10%) Ninety per cent of gallstones are radiolucent, i.e. they do not show on a plain X-ray (unlike renal calculi, of which 90% are radio-opaque).

Predisposing factors to gallstone formaton include:
1. female
2. sex (three times more common)
3. obesity,
4. age (10% of <50-year-olds have gallstones, and 30% of <70-year-olds),
5. Haemolytic anemia
6. Hyperlipidaemias
7. Crohn’s disease.


Some people appear to have a tendency to form gallstones and are said to have ‘lithogenic bile’. People often refer to the typical gallstone patient as 4F which is fat, female, fertile and forty. Ok? So remember that 4F if u cant remember the risk factors

Complications of gallstones can be divided into 3:
1. In the gallbladder
  • Chronic cholecystitis
  • Biliary colic
  • Acute cholecystitis
  • Empyema
  • Biliary peritonitis
  • Abscess
  • Mucocele
  • Carcinoma of gallbladder
2. In the common bile duct
  • Obstructive jaundice
  • Cholangitis
  • Pancreatitis
3. In the gut
  • Gallstone ileus

BILIARY COLIC

Biliary colic is the pain that associated with irritation of the viscera secondary to cholecystitis and gallstones or in a specific terms caused by gallbladder muscle spasms against a stone stuck in the neck of the gallbladder (Hartmann’s pouch) or the cystic duct. It may account for some of the symptoms for chronic cholecystitis. Unlike intestinal colic, the pain was continuous and not in waves. It is usually felt in the epigastrium or right upper quadrant and may radiate around both costal margins and into the back. The pain can be extremely severe and patients may be sweaty, pale and tachycardic because of it. They may also feel nauseated or vomit. They will usually be unable to get comfortable and will prefer to writhe around rather than stay still. Attacks usually last less than six hours and examination is usually otherwise normal. Differential diagnoses include other causes of severe upper abdominal pain, such as perforated peptic ulcer, pancreatitis, ruptured aneurysm, etc. Management involves giving analgesia, investigation to confirm gallstones (ultrasound) and subsequent cholecystectomy in most cases.

ACUTE CHOLECYSTITIS

History

At early stage acute cholecystitis may appear to be biliary colic, and indeed many attacks of acute cholecystitis probably start with biliary colic! The exact mechanisms of acute cholescystitis are poorly understood but they said that it are caused by chemical inflammation within an obstructed gallbladder. Bacterial infection probably is a secondary event in about one-third of cases and these may be the ones most likely to develop complications.

Patients will typically have symptoms of severe right upper quadrant or epigastric pain. Like biliary colic, this may radiate around the costal margins or into the back. However unlike biliary colic, patients will prefer to lie still and take shallow breaths (this is now a form of local peritonitis, not colic). They will usually have a temperature and tachycardia, and may also have nausea and vomiting.

Physical examination

Murphy’s sign may be positive and is often asked about in short case. It is elicited by pressing in the right upper quadrant under the costal margin. The patient is then asked to breathe in, and winces or gasps with pain as the gallbladder moves down and hits the examiner’s hand. The test should also be performed in the left upper quadrant to exclude nonspecific reactions due to other pathology.

A mass may be present in the right upper quadrant, but if so this is not usually the gallbladder itself but rather a ‘phlegmon’ (i.e. inflamed andadherent omentum and bowel around the gallbladder).

Investigation

The most important confirmatory test is an ultrasound scan. US confirm gallstones, showing thickening and oedema of the gallbladder wall and localise the tender spot to the gallbladder itself. It can also exclude dilatation of the common bile duct and other pathology, such as liver masses.

Image through the long axis of the GB (GB) demonstrates the gallbladder neck (red arrow). GB wall thickness is measured between the gallbladder lumen and the hepatic parenchyma (red arrowheads) with normal thickness <3cm

Only very occasionally is a HIDA scan used to help confirm or exclude cholecystitis. The principle of this test is that HIDA (a radioisotope) is taken up by the liver and excreted into the bile. If the cystic duct is patent, it will fill the gallbladder effectively, excluding cholecystitis.

Management

The treatment of acute cholecystitis is initial resuscitation with intravenous
fluids and antibiotics. The patient will normally be kept nil by mouth or on sips of clear fluids, and initial investigations will be arranged, including basic blood tests such as an FBC (usually the white cell count is raised), U & Es, LFTs and amylase (as acute pancreatitis may be a differential diagnosis).

With conservative treatment approximately 80–90% of cases of acute cholecystitis will settle over the next 24–48 h (i.e. the pain settles, the temperature falls and the patient’s abdomen becomes nontender). In about 10% of cases there will not be a prompt resolution of symptoms and signs, and in these cases surgery is usually advised.

Particularly worrying signs are increasing temperature, tachycardia and the onset of increasing tenderness or the signs of peritonitis. These may indicate infarction of the gallbladder (gangrenous cholecystitis) or perforation, which may produce either a local collection or generalised peritonitis. A gallbladder full of pus (empyema of the gallbladder) usually leads to an unwell patient with the signs of sepsis (fever, tachycardia, hypotension, etc.) as well as pain, and tenderness in the right upper quadrant.

More controversial is the question of what to do with patients who do not absolutely require early surgery. Although conventional management is to allow the acute episode to settle down and to readmit the patient for elective cholecystectomy 6–8 weeks later, many surgeons now prefer cholecystectomy in the acute phase. This allows patients to recover quicker and to be spared further episodes of pain. Laparoscopic cholecystectomy can now be carried out in the acute phase by experienced surgeons.



CHRONIC CHOLECYSTITIS

Chronic cholecystitis is a term used to describe symptoms of upper abdominal pain, indigestion, bloating, burping, nausea and occasional vomiting. Sometimes this symptom complex is called flatulent dyspepsia. The patient may describe the symptoms as being precipitated by fatty food (fats stimulate the release of cholecystokinin, which causes gallbladder contractions). There is usually nothing to find on physical examination.

The main differential diagnoses include
1. peptic ulceration
2. hiatus hernia
3. irritable bowel syndrome.

Because gallstones are so common, it's important not to automatically discribe such symptoms to them simply because that gallstones are present on an US scan. A missed peptic ulcer or irritable bowel syndrome will obviously not be helped by unnecessary cholecystectomy! And the patient will continue to get those symptoms. If the symptoms are thought to be arising from the gallbladder and are significant, then the treatment is cholecystectomy, usually laparoscopic.

Attempting to dissolve gallstones using 'bile salt therapy' might be possible for patients with small, noncalcified stones. It also reserved for those who refuse or unfit for surgery. However bear in mind that this treatment is not very successful.

CHOLANGITIS

Cholangitis is a condition where there is infection within the biliary tract and it is rare unless there is associated obstruction. This is a demonstration of the surgical principle that obstructed tubes tend to get infected, i.e. appendicitis, pyelonephritis, etc. Cholangitis is clinically manifested by Charcot’s triad of pain, jaundice and rigors (rigors means involuntary shaking in association with pyrexia). It requires prompt diagnosis and treatment, otherwise it can have a high mortality. Treatment consists of resuscitaton with fluids and the administration of intravenous antibiotics. If resolution is not rapid, then attempts to produce biliary drainage, endoscopically, radiologically or surgically, are required.

That's all for today! Happy revising!



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Teke teki 2.. LOLZ
5/30/2009 06:25:00 PM | Author: fadzly ex-extenders
1) Minyak ape yang disukai oleh lelaki?
Answer: MINYAKsikan pertandingan bolasepak EPL .....

2) Kuih ape yang bungkusnya di dalam, isinya di luar?
Answer: Kuih salah bikin...

3) Binatang ape power Karate?
Answer: Kuda belang.cube kira brape black belt dia
ade...


4) Siape yang menemukan dompet kulit?
Answer: Yang menemukan dompet kulit tersebut
tolong pulangkan kepada saye...


5) Pintu ape yang walaupun dengan 10 org pun tak leh nak tolak?
Answer: Pintu yang ade tulis 'TARIK'...

6) Saya ade 3 kepala, 4 tangan dan 5 kaki...siapakah saya?
Answer: Pembohong...

7) Apa dia 'Jauh di mata, dekat di hati'?
Answer: Usus...

8) Binatang ape yang seluruh anggota tubuhnya kat kepala?
Answer: Kutu rambut...

9) Nenek sape jalannya meloncat-loncat?
Answer: Neneknye si katak...

10) Knape lelaki jarang kene penyakit anjing gila?
Answer: Sbb lelaki ni kan 'buaya'...

11) Ape beza sekretari baik ngan sekretari kurang baik?
Answer: - Sekretari baik..................'Selamat
pagi tuan' - Sekretari kurang baik...........'Dah pagi ni tuan'...


12) Ape persamaan Michael Jordan ngan Michael Jackson?
Answer: Dua-dua tak kenal korang...hehe

13) Tukang ape yang kalau dipanggil, die menjenguk
ke atas?
Answer: Tukang gali kubur...

14) Nak mencari sikit punye susah, bile dah dapat
buang, ape bendanya?
Answer: Tahi hidung...

15) Ape persamaan kain jemuran ngan telefon?
Answer: Dua-dua kalau dah 'kringgg' bole diangkat...

16) Knape pokok kelapa kat depan rumah harus ditebang?
Answer: Mestilah kene tebang, sape nak cabut pokok kelapa ...gile ape...

17) Gajah terbang dengan ape?
Answer: Dengan susah payah....

Hehe.. Mau jawapan proceed.. kekekeke
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Manchester United training pass utk dilelong!!
5/29/2009 02:46:00 PM | Author: fadzly ex-extenders
If you want to bid click here





Starting price:rm50/pass
Quickgrab:RM300/pass
Deadline:14th june 2009
5 training pass only

p/s just leave your price and contact number at the comment box. We will call the winner on the the dateline!! The highest bidder will be the the winner!! Only 5 passes up for grab.

To those who wants us to buy the tickets for the match, can do so.
We only charge extra rm5 per ticket.
Shipping fees are not included.
(bape sen sgt jer.sape2 yg duk jauh tuh bolelah).

Anything just call 0194023092....MrDon







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MBBS MALAYA, UM EXTENDERS
5/28/2009 08:12:00 PM | Author: fadzly ex-extenders

Why do we fail in exam??

For every medical student, finals seem a daunting prospect. However, the truth is that most candidates pass the exam easily and most junior doctors look back at finals as being relatively straightforward, not me saying that, them.. The reason for it is that exam is simply a long and draining race and by the time you have arrived this point, the odds are with you to finish the course.

For many of us might think that the examiners are not there to fail candidates per se; in fact, the opposite is true and they are really trying to help you pass. However in some like our case, they must ensure that a safe junior doctor is unleashed on the public. Because of this, we must know the basics of all the common emergency situations. Luck plays only a small part in finals for most students and, there is a quote “The harder you work, the luckier you get.”



There is no doubt that the best performers in final MBBS candidates are those who think logically. They express themselves clearly and avoid putting their foot in their mouth by saying something stupid like i did before.. Their knowledge depth might not necessarily greater than that of their fellow candidates, but they do well in every part of the exam — writtens, clinicals and OSCE.

Tips for exam

The message is clear: We must start early! We need to practising a systematic approach to the subject. There might be certain approach that we've been told by our seniors or friends, but you may not like all of them, so choose a method that we can use and spend a great deal of time perfecting it. Also, note that a short pause before answering does not detract from the answer and may avoid a dreadful mistake

Objectives

The purpose i build this blog is sharing. I love putting articles that are based on medicine so that many of us will benefits from it. Over the last few years, the world of medicine has moved on with advances in almost every field. With this in mind, apart from putting what we've learn during this 6 months, I decided to bring the text which this articles are up to date and to bring in expertise to co-author many of the chapters, especially those in which we were no longer experts! LOLZ. Each articles will be reviewed and updated by the co-author whose name is listed at the side of the blog making the only blog which comprehensively reviews from all specialities required for final MBBS examinations! What an ambitious things to do. Thus, i urge to my colleagues and my juniors to make this as a reality not a as a delusion.
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Lap2win - Vote For Aizuddin Akmal Group
5/28/2009 07:40:00 PM | Author: fadzly ex-extenders

We are joining this LAM2WIN. This Competition basically about an open source - php, apache etc2.. No need to elaborate, i just want your help now! hehe! Please do Vote for Aizuddin Akmal, so that our group will have a chance in winning this competition. How to vote? Easy as ABC. Just click the banner and check the Azuddin Akmal and click vote!
We really appretiate it. Thanks in advanced.



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SPM: Maksimum 10 Subjek
5/28/2009 06:07:00 PM | Author: fadzly ex-extenders
May 28, 09 2:18pm
Setiap pelajar yang menduduki Sijil Peperiksaan Malaysia (SPM) hanya dibenarkan mengambil 10 subjek maksimum mulai tahun depan.

Serentak dengan itu, beberapa perubahan akan dilakukan terhadap sistem pengredan SPM, kata Timbalan Perdana Menteri Tan Sri Muhyiddin Yassin.

"Ia akan mempunyai banyak implikasi positif, satu yang pasti adalah para guru akan berupaya memberi lebih tumpuan terhadap bilangan mata pelajaran utama dan guru juga akan lebih khusus," katanya kepada pemberita selepas melakukan lawatan kerja ke tapak projek Kompleks Pendidikan, Bandar Enstek di Nilai hari ini, lapor Bernama.

Muhyidin, yang juga menteri pelajaran berkata, daripada setengah juta pelajar yang mengambil SPM sebelum ini, kira-kira 48,000 pelajar mengambil lebih daripada 10 subjek.
Adik Nik Nor Madihah with her 20A's. 19A1 and 1A2

Adik Nur Amalina Che Bakri, the first student who shock the country with 17A's

Ini juga akan mengatasi masalah pada sesetengah subjek yang kekurangan guru, malahan ibu bapa dapat menjimatkan wang daripada terpaksa membayar lebihan subjek perlu diambil apabila menghantar anak mereka ke kelas tuisyen, katanya.

Muhyiddin berkata kementerian amat serius untuk merapatkan jurang di antara pelajar bandar dan luar bandar walapun perbezaan jurang ini tidak sejauh mana.

"Sebenarnya jurang ini tidak terlalu jauh tetapi masih ada perbezaan yang agak ketara dari sudut lain dan ini dilihat dari segi keputusan peperiksaan," katanya.


Pembaharuan yang dilaksanakan pada Rancangan Malaysia Ke-10 membabitkan pembangunan prasarana, tenaga guru dan cara pembelajaran murid, katanya.

"Lebih-lebih lagi di kawasan luar bandar ini terdapat ramai orang bumiputera Melayu, bumiputera yang agak miskin, kurang berkemampuan.

"Kita mahu pembangunan sekolah-sekolah di luar bandar sama tahapnya baik dari segi infrastruktur, cara pembelajaran sebagaimana yang terdapat di kawasan-kawasan yang sudah maju," kata Muhyiddin.

Beliau turut menyentuh mengenai kepentingan guru-guru yang berkelayakan untuk mengajar bahasa Inggeris, Sains dan Matematik di pedalaman merupakan cabaran utama bagi kementeriannya melaksanakan pembaharuan itu.

Walaupun kementerian ada menawarkan elaun sebanyak RM1,500 sebagai insentif sejak dari tahun lalu untuk mereka datang ke kawasan pedalaman misalnya di Sabah dan Sarawak, tetapi masih banyak cabaran lain perlu ditangani.

Beliau sedang memikirkan cara untuk menyenangkan kehidupan guru-guru yang dihantar ke kawasan pedalaman ini kerana walaupun mendapat elaun, kementerian sedar masalah lain seperti perumahan menjadi asas utama perlu diatasi.

Lolz.. why need more than 10's? I've taken 9 and managed to get only 3 A1. So difficult if too many subject we need to focus on. Do we really need to take more than that? What are we after for anyway? The best student in the country? What do they get? Big income? Famous? Hall of fame?
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BERKABUNG.. TAK MO MEN BOLA SEBULAN..
5/28/2009 04:57:00 AM | Author: fadzly ex-extenders
SELEPAS MAN U KALAH, TAK TERINGIN RASANYA NAK BLI TIKET MAN U vs MALAYSIA... SAD2.. TAK MO LAGI MEN BOLA.. ARGHHHHHH!!!

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First and the last day of surgery posting!
5/27/2009 09:58:00 PM | Author: fadzly ex-extenders
Congratulations to my group members! WE'VE been to the surgical ward at last! and good luck for our next posting. May Allah bless us. amin.
hahaha..



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Happy Birthday
5/26/2009 02:38:00 PM | Author: fadzly ex-extenders
Today is Fitri's birthday.. We from the extenders, wish him a very happy birthday at perak..LOLZ..
Miss the old klang hospital memories where the traditions begin ..



Nway this is fitri



If only i can freeze the time we spend together.. What a good, i mean the best memories we've got together at klang..
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Windows 7, low yat, and... Code 43.
5/25/2009 05:15:00 PM | Author: fadzly ex-extenders

Windows 7 and the problem

Windows 7 RC was out. Then last week i ask my little sister to brought her notebook to me to installed the new windows. I was so eager to install because all of my friends installed it without any prob. Windows 7 was marvelous. Eventhough it only an RC version, the features are so advanced and Vista is not match for it. Her computer was ok until prior to 3 days ago I've got a blue screen when i surfing the net using firefox. The problem was "CODE 43" something related to Graphic card responding to windows that the card got some error thus makes the graphic unusable and makes the windows 7 ultimately become windows "safe mode"... Agrhghhh.. I've been working for my sister's notebook for the past 3 days without any solution! I've tried to format back to XP, VIsta also no hope. My eyes was so tired sitting infront of the monitor surfing for solutionI even called the acer center and try to get a solution. - "Oh, currently we don't suggest you to use WIndows7 because we don't have any driver that is compatible with it. Please use windows XP or Vista, ORIGINAL. LOLz.. I've tried to pressure him that i don't think this is a software prob. It's genuinely hardware problem i said but he just wont listen. Damn you acer. I even post this problem at lowyat.net forum at Technical Support Section. No reply.



Adik

Then I've concluded that I cant fix it. So I wanna gave it back to adik so that she cant sent it to warranty. Suddenly the computer back to normal! I dont know how on earth did she do that when the comp in her arms. She's got a miracle hands? Then i took it back to installed all the necessary software. Soon after that i went back to my room and OMG, the CODE 43 appeared again..

Lowyat and Big Apple

Then I've fed up and wannna send it to warranty department myself at lowyat. After a hard drive to lowyat with Najmi, i showed the comp to the technician there. Suddenly, "normal", said the technician.. the computer has not shown any problem! WTF. how come? i said. Then i later not satisfied i even try to restart multiple time! I ask najmi, did we have hallucination? I even showed him a proof of screen shot i taken earlier.



Damn.. What a hard work that we went to lowyat for nothing.. But there was also some best part which i bought some Big APPLE (i love the Alien, yummy, got so many choc outside and inside the donuts). After arrived, I've test again the notebook. WHAT THE ****. The CODE 43. It happened again!!!


Fixed

The trend - Problem was intermittent and it only happen in my room. I could see each time it happened only when i put on my external hard disk to the notebook before booting the computer. Thus the only solution here is to plug off any USB connected to the notebook to make it more power stable! It works! Sigh... At last i can relax my eye and take a full 12 hours of sleep, really?

Friends and Manchester United

Not really. Just when i wanna start to close my eyes, My besfriend, Hashim comes and asked me to watch Hull vs Man U. For me, no use for me to watch the match because MU has won already! I cant resist because he wanna treat me at Mapley. So we watched. Man U won again and won 1-0 nicely from Gibson. They played with a lot of fresh players. We'll see a very good future for Man U. They got so many good young player!
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Your YM have been illegally use as a spammer
5/24/2009 07:26:00 AM | Author: fadzly ex-extenders
I've left my computer on for 24 hours, and surprisingly I woke up this morning, SPAMS IN MY DESKTOP! How on earth could they got your login. Good thing is you can still use your YM because one of you recently chatting with me. But bad thing was Your info's are exposed, your mails, your ID at other website, your credit card info, and etc2.



Important: Those who infected wont know they are! So the only way that they will know is just by telling them and i hope they read it. LOLZ

I just wondering, did i also send spam to you? If i do, please tell me.

Here are the lists of my frens Yahoo! ID that have been exposed to spammer hacker:

1) nona_85
2) Schultz_0085
3) syerry_syadyna03
4) Syier_scots
5) Hazz_lina
6) butterwontmelt86
7) Che_sue
8) imosh85
9) jnrhyuk_sll03
10)star_space97
11)fieza_vicks

So, i just hope that those YM id above can take action with the situation because your ID has been use illegally and all your data/info might been exposed. I don't know how to handle this, but the best way is to format your computer and on firewall and do antivirus checkup and change your Yahoo! ID password. Just my 2 cent.

Update 8.05 a.m.: I've just found what the possible cause of your ID being taken by spammer! Mostly because they installed some third party program in their Yahoo Messenger! The other cause is there might be phishing website that asking for your ID and password! Thus, the only way that i think work is basically just like above but no need to format. Just run antivirus, uninstall all the third party program for yahoo messenger and install the latest version of yahoo! messenger and change your password immediately!

Prevention: those who don't want your ID being taken by this spammer, 1st don't ever give information to website that is other than Yahoo! or just install On the Phishing protection in IE. 2nd don't ever install any third party software eventhough the smileys there was so cute and animated. HEY. who cares the Smiley are cute or wat so ever, there's not a lot of ppl using it!

Proceed to view the spam messages


BUZZ!!
Are you finally ready to lose some weight with no effort, well I am living proof that those acai berry pills everyone is talking about actually work, I lost 22 pounds in two weeks and it only cost me five dollars over at http://hellsec.com

BUZZ!!
Well I finally ordered those acai berry pills that I have been hearing about all the time and it has been 2 weeks now and I lost 22 pounds already, so I am living proof that they did work and still are working, best of all they cost only five dollars to try at http://hellits.com

BUZZ!!
Woah those acai berry pills are no joke I just lost like 23 pounds in two weeks, I am living proof that they work with no special diet or nothing, they only cost me five dollars over at http://helljaw.com

BUZZ!!
Woah those acai berry pills are no joke I just lost like 23 pounds in two weeks, I am living proof that they work with no special diet or nothing, they only cost me five dollars over at http://helljaw.com

BUZZ!!
I have been so skeptical lately on ways to lose weight, but I have to tell you, I found the way finally that works. I lost 23 pounds in the past two weeks with acai berry pills the same ones that were on oprah, they cost me only five dollars over at http://tyrtyr.com

BUZZ!!
Do you realize that If I would not have tried those acai berry pills that everyone is talking about that I would not have lost 23 pounds in just about two weeks now? Well they do work, I am living proof and they only cost five dollars over at http://kitemust.com

BUZZ!!
Woah those acai berry pills are no joke I just lost like 23 pounds in two weeks, I am living proof that they work with no special diet or nothing, they only cost me five dollars over at http://lainfact.com

BUZZ!!
Well I finally ordered those acai berry pills that I have been hearing about all the time and it has been 2 weeks now and I lost 22 pounds already, so I am living proof that they did work and still are working, best of all they cost only five dollars to try at http://kindmane.com

BUZZ!!
Hey, how are you. Just wanted to let you know about these new supplements I tried. I lost 12 pounds in just a week and a half. Best thing, it only cost me $5. Check it out here: http://poundsdrop.com

BUZZ!!
Ever since Derek and I seen those Acai pills on Cnn and Oprah we have been taking them and losing so much weight so fast with no diets or excercise , we are living proof that it works like magic and they are only five dollars now to try from http://modehere.com

BUZZ!!
I have been taking Acai tablets now for two months and already lost 36 pounds, it is the same stuff that was on oprah and cnn, Mike and Jen lost so much weight too with no diet or excersise. Order it now, only five dollars a bottle, we are living proof that it works like magic. Get it over at http://nowkeeps.com

BUZZ!!
Finally I lost over 31 pounds in less then a month, these new Acai tablets that Jess and I been taking are amazing. They just work super fast on your body fat without any diets or excerice best thing? Cost just 5 dollars over at http://knowflap.com

BUZZ!!
Ever since Dylan and I seen those Acai pills on Cnn and Oprah we have been taking them and losing so much weight so fast with no diet or excercise , we are living proof that it works like magic and they are only five dollars now to try from http://tickcapes.com

Buzz!!
I just have to let you know, I actually ordered those acai berry pills that I heard about on oprah and in messages on here, well I been on them for two weeks and lost 21 pounds so far, so I am living proof that they really do work, they are only five dollars over at http://doortry.com

Buzz!!
I got so many messages about those acai berry pills that I decided to order them and guess what? I lost 23 pounds so far and its only been two weeks. I am living proof that they work and best part was, they only cost me five dollars to try over at http://traintry.com

I got so many messages about those acai berry pills that I decided to order them and guess what? I lost 23 pounds so far and its only been two weeks. I am living proof that they work and best part was, they only cost me five dollars to try over at http://updark.com

Well I finally ordered those acai berry pills that I have been hearing about all the time and it has been 2 weeks now and I lost 22 pounds already, so I am living proof that they did work and still are working, best of all they cost only five dollars to try at http://prevsea.com

A word of advice from a friend here, I ordered those acai pills that I kept hearing about from everyone and on oprah too, well its been two weeks now and I lose 22 pounds and still losing more, I am living proof that they do work, try them for only five dollars at http://nextprev.com

Woah those acai berry pills are no joke I just lost like 23 pounds in two weeks, I am living proof that they work with no special diet or nothing, they only cost me five dollars over at http://prevbreak.com

You must have seen all those ads and messages lately about acai berry pills that make you lose weight, well I took the plunge spend five bucks to try them and its been a couple weeks and I dropped 21 pounds already, I am living proof they do work, get them now at http://nextprev.com

Do you realize that If I would not have tried those acai berry pills that everyone is talking about that I would not have lost 23 pounds in just about two weeks now? Well they do work, I am living proof and they only cost five dollars over at http://prevsea.com

I just have to let you know, I actually ordered those acai berry pills that I heard about on oprah and in messages on here, well I been on them for two weeks and lost 21 pounds so far, so I am living proof that they really do work, they are only five dollars over at http://coldfirst.com

Are you finally ready to lose some weight with no effort, well I am living proof that those acai berry pills everyone is talking about actually work, I lost 22 pounds in two weeks and it only cost me five dollars over at http://coldscreen.com

I just have to let you know, I actually ordered those acai berry pills that I heard about on oprah and in messages on here, well I been on them for two weeks and lost 21 pounds so far, so I am living proof that they really do work, they are only five dollars over at http://planewalk.com

Did you see that report on ResV pills I found a place that let's you try them for for only five dollars, all I can tell you is get them fast, they do work and you feel it right after the second dose http://sweettier.com

Are you finally ready to lose some weight with no effort, well I am living proof that those acai berry pills everyone is talking about actually work, I lost 22 pounds in two weeks and it only cost me five dollars over at http://towntwist.com

I just have to let you know, I actually ordered those acai berry pills that I heard about on oprah and in messages on here, well I been on them for two weeks and lost 21 pounds so far, so I am living proof that they really do work, they are only five dollars over at http://goodregon.com
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I've got a copyright claim from skyscape! LOLZ
5/22/2009 11:08:00 PM | Author: fadzly ex-extenders
WTF! i got a copyright claim from skyscape - viral@skyscape.com. He claim he was 'the owner' of skyscape. U wanna know him? click here and here.. I usually dont open my gmail until today, Anonymous MS told me someone has send regards to our blog. LOLZ. Then i opened my mail and i found this
Diri ini terasa sangat la bengang.. I'm just seorang yang biasa saja. Tak mahula jadi macam raja petra asik ada kontroversi dengan blog. Anyway, waiting for Anonymous MS to comment about this..

Viral Dalia to me

Dear Website Owner,

I act on behalf of Skyscape Inc., (the “Owner”).

It has come to the Owner’s attention that you are providing illegal ways to use the Owner’s contents on your website/blog http://mbbs-extender.blogspot.com . The page in question is http://mbbs-extender.blogspot.com/2009/05/skyscape-cracking-guide-part-1.html. As you know, under software piracy & copyright law of United States of America, this kind of practice is not legal without the Owner’s permission.

Kindly remove the content from your website immediately.

Sincerely,

Webmaster,

Skyscape Inc.,

skysc_logo






What I've done? I'm just an ordinary blogger, and i didn't do any illegal things. Right now I'll just make the post public and i want google or blogger team to judge themselves by reading the articles first or do some investigation before act.

To Viral - F word for u.. Maybe i should put spam on your email.

And for the continue of the post, Part 3 (the real CRACK version), Anonymous MS will post it at the other blog/web or somewhere else.


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Hip hope
5/22/2009 10:51:00 PM | Author: fadzly ex-extenders
Hip resurfacing surgery offers relief for younger patients. SUZANNA PILLAY finds out how.



A COMMON type of hip arthritis characterised by the progressive wearing away of the cartilage of the afflicted joint, osteoarthritis can be very painful when it increases in severity.

It also affects movement, causing stiff hips, limited range of motion and an awkward gait, amongst other complaints.

“The general rule of thumb that doctors follow when dealing with patients with severe hip arthritis is to recommend total hip replacement (THR) surgery. However, they normally tell patients to wait until after they’re 60 years old, to undergo this surgery.

“THR is not done on the more active and younger patients or on athletes because the wear rates are very high,” said Dr K.

Sivanathan, consultant orthopaedic and arthroplasty surgeon, Tropicana Medical Centre in Petaling Jaya.

This is because in reality, many hip pain sufferers under the age of 60 will outlive a traditional hip replacement and may require additional surgeries (revision hip replacement surgeries) in their lifetime.

He said surgeons were concerned about possible complications that might surface in later revision surgeries because every time it is done, a larger surgery and larger implant had to be used.

Apart from revision surgery, other concerns about THR was the lack of femoral head (thighbone) preservation, reduced range of movements and higher risk of dislocation of implants in more active patients.

“If anybody were to do a THR, we would advise them not to squat or sit in a very low chair, because dislocation can occur. The implant head size is only 28mm in diameter so if you move it beyond a certain angle, the whole thing comes out, as opposed to a normal femoral head which has a higher range of movements.” Instead, younger patients were encouraged to live with their condition as best they could, dulling the pain with anti-inflammatory pain medication, joint supplements like Glucosamine and undergoing physical therapy to strengthen the muscles around the hip joint.

But today, the situation is different, thanks to improvements in hip resurfacing surgery implants. Young and active patients don’t have to live with hip pain anymore.

“Hip resurfacing surgery is an advanced surgical procedure for osteoarthritis and hip-related injuries that is suitable for younger or active patients under 60,” said Dr Sivanathan.

“The procedure is a minimally invasive, bone-conserving alternative to conventional total hip replacement because unlike THR, hip resurfacing preserves the head, neck and femur bone. “The femoral head and neck are not removed as in a THR. Instead, the femoral head is reshaped to accept a metal cap placed on the ball of the ball-and-socket hip joint, while the second piece is a cup that forms the socket of the joint. As the hip surfacing implant is made entirely of metal, there is a reduced risk of osteolysis and associated early loosening.” Another plus is that unlike THR, it also made replacement surgery easier. He said if the hip resurfacing implant wears out after 15 years or so, or developed problems, the revision surgery would simply convert it to a standard THR.

However, he said hip resurfacing surgery was not entirely without risk. If the procedure is not done correctly, the femoral neck can break. The person performing it has to be properly trained.

“Also, the hip surfacing implant has to be fitted at the correct angle and care must be taken not to notch the neck when preparing the femoral head to accept the cap.” Dr Sivanathan said patients who undergo hip resurfacing surgery would be given thromboprophylaxis during surgery and shortly after the operation to prevent deep vein thrombosis (DVT).


“It has been noted that in any surgery involving pelvic fractures, abdominal operations, hip procedures and knee replacements, there is a higher incidence of DVT because the patient would be recumbent in bed for a while.” The issue was highlighted last week (May 11-15), during Thrombosis Awareness Week. It was noted that patients going to hospitals for surgery were at risk from venous thromboembolism (VTE) where blood clots form in the leg veins (DVT), which may then break off and block blood vessels in the lungs, causing pulmonary embolism.

“Deaths from VTE can be minimised through thromboprophylaxis, which is the use of preventive medication, especially in those patients identified as bearing high risk of VTE. These include advanced age, obesity, immobility, pregnancy and past experience with DVT or PE,” said Dr Jamal Azmi Mohamad, consultant orthopaedic and trauma surgeon.

Although exact figures are unavailable, a study conducted in Malaysia among 88 patients who had undergone surgery for total knee replacement, total hip replacement and fracture of the proximal femur with no prophylaxis, found that 55 of them (62.5 per cent) showed evidence of DVT. The prevalence was highest after total knee replacement (76.5 per cent), followed by total hip replacement (64.3 per cent) and lastly, the fracture group (50 per cent).

Dr Jamal, who is also the former president of the Malaysian Orthopaedic Association, said there is a strong need to implement primary prophylaxis to prevent thrombosis, as it is potentially life-saving and more effective than treating complications that may result.

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Convert IreansAV to mp3!
5/21/2009 01:21:00 PM | Author: fadzly ex-extenders
See video below to convert ireansAV to MP3!!!


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Download Video From IreansAV!
5/21/2009 07:27:00 AM | Author: fadzly ex-extenders
Want to download Video from ireansAV but you dont know how? I will show you how to download it here with a video guide specially made just for ireanster.. HAHA.. proceed below to view the video



next project - 1 click - Convert ireansAV video to mp3 and download it!
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Darwin Validated?: Missing link found?
5/20/2009 08:39:00 PM | Author: fadzly ex-extenders


What is missing link?
Missing link is the link that have been missing or the species that have missing in the line of an evolution of a man or just a fact for the Darwin's theory to be true. The group of scientists claim that they have discovered “Ida,” a 47-million-year-old fossil that has been proclaimed the “missing link” in connecting human skeletal structure to early mammals.

Scientists found it in Messel Pit, Germany. They found out that she is about twenty times older than most fossils related to human evolution. What makes Ida so special? she has certain undeniable human characteristics such as forward facing eyes and even an opposable thumb.

What makes me post this article? Is this really a 'missing link' or is this just another plain species of monkeys that have gone extinct? What proof do they have of it being 46 million years old? Maybe we're all just too naive and believe whatever scientists claim because they're suppose to be 'educated' and 'know' things. "The "Darwin validated" headline from all over the news (you can just google it) makes it sound like evolutionary biologists were waiting for this one fossil to prove that evolution is true -- which is not the case."

The words "Darwin validated" makes it sound like they've been waiting a long time for just this fossil to show up so that the Darwinists could laugh and say, "We were a part of the animal kingdom afterall! We're nothing but animals that have evolved over millions and billions of years!" Shouldn't the other aspects be considered? What if that fossil is nothing but a fake, just like all the hoaxs that were suppose to support evolution from the past?

So how does this fossil link fit in the evolutionary chain? A "missing link" should be placed in a sequence, otherwise it's a random piece. Did apes suddenly become smaller and grow tails and suddenly become larger and loose their tails to become humans? It may have human characteristics, but doesn't fit a sequence.

Where are the thousands and thousands of fossils of other morphological changes necessary to change from early prosimian to a human?

Charles Darwin wrote, "If it could be demonstrated that any complex organ existed which could not possibly have been formed by numerous, successive, slight modifications, my theory would absolutely break down." We don't have "numerous, successive, slight modifications".

To my scientific mind Darwin's Theory is still a theory. Until more evidence can be produced, the "fact of evolution" is unfounded and therefore premature. This may well be a very unpopular stand but that doesn't change the reality that evolution is far from being proved.


I still remember the "Java Man" (I'm Javanese anyway), there weren't any fossils that supported Darwin's theory on his time (eventhough there isn't any today either). All the scientists found were a human (or maybe an animal skullcap), a couple of teeth and bones

The "Nebraska man"? All the scientists found was an extinct pig's tooth for goodness sake. The Piltdown man? They found a human skull, chimpanzee's tooth and an orangutan's jaw. They put it together and said, " WE HAVE THE MISSING LINK!" How serious can you get? This fossil, supposedly the 'missing link,' is probably nothing more than an extinct type of monkey.

Founding the fossil was very fascinated but concluding the discovery as the missing link or Darwin Validated is indeed, very prematured. This discovery helps to support evolution, not validate it.

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